This career development award will provide Dr. Curtis Weiss the opportunity to develop as an independent researcher of translating research into clinical practice using implementation science and complex network analysis, and to improve the care of patients with acute pulmonary diseases. The current paradigm of implementation is limited because of an ineffective system of translating evidence-based innovations into clinician practice and a lack of understanding about how clinicians learn about and adopt new therapies. Dr. Weiss will use this award to enhance his existing skills with new skills in implementation science and complex network analysis. These skills will allow him to investigate new implementation methods and a better model of how clinicians learn about and adopt evidence-based innovations. He will achieve these career goals through a career development plan that consists of formal coursework, intensive mentorship, and patient-oriented research. His primary mentor is Dr. David Baker, an expert in implementation science with multiple active NIH grants and an outstanding record of mentoring. His co-mentors include experts in implementation science (Dr. Stephen Persell), complex network analysis (Dr. Luis Amaral, a Howard Hughes Medical Institute Early Career Scientist), and ALI, acute respiratory failure, and critical care outcomes (Dr. Richard Wunderink). This will be accomplished at Northwestern University and collaborating clinical sites. Northwestern provides dedicated support from the Division of Pulmonary and Critical Care Medicine and Department of Internal Medicine; 2) his multidisciplinary team of mentors; 3) numerous courses and professional interactions relevant to his career development, including the Northwestern Clinical and Translational Sciences Institute and the Northwestern Institute on Complex Systems; 4) research infrastructure that includes bioinformatics support to design and implement an electronic health record intervention, as well as an institutional electronic data collection program and biostatistical support; and 5) extensive clinical infrastructure. Dr. Weiss with 1) The overall purpose of the research strategy is to use implementation science and complex network analysis to investigate a comprehensive strategy that implements lung protective ventilation and Awake and Breathing Controlled (ABC) weaning, improving the care of patients with acute lung injury (ALI) and acute respiratory failure, respectively. The study will be conducted at one academic and several community hospitals. Specific Aim One will determine the current rate of utilization of these two therapies and link these rates with physician, nurse, and respiratory therapist (provider) knowledge and attitudes about these therapies. Specific Aim Two will use complex network analysis to identify provider opinion leaders at each institution. Specific Aim Three will be a clinical trial that determines whether a multi-faceted, multidisciplinary intervention comprised of opinion leader learning collaboratives, electronic alerts and reminders, and audit and feedback increases implementation rates of low tidal volume ventilation and ABC weaning compared to usual care.